Dexmedetomidine use and mortality in mechanically ventilated patients with severe burns: A cohort study using a national inpatient database in Japan |
| |
| Affiliation: | 1. Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan;2. Health Services Research & Development Centre, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan;3. Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan;4. Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, 280, Sakurano-sato, Ibaraki-machi, Higashi-Ibaraki, Ibaraki, Japan;5. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan;6. Department of Pediatrics, Tsukuba University Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki, Japan;1. Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States;2. Doctors Collaborating to Help Children, Boston, MA, United States;3. Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States;4. Shriners Hospitals for Children - Boston, Boston, MA, United States;5. Department of Surgery, St. Agnes Hospital, Baltimore, MD, United States;6. Department of Pediatric Surgery, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine;7. Medicover Group, Lviv, Ukraine;1. Department of Surgery School of Medicine, Iran University of Medical Sciences, Iran;2. Department of General Surgery, School of Medicine, Burn Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, Iran;3. Department of Psychiatry School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran;4. Iran University of Medical Sciences, Tehran, Iran;5. Department of Plastic Surgery, School of Medicine, Burn Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, Iran;1. Institute of Burn Research, Southwest Hospital, the Army Medical University (Third Military Medical University), Chongqing 400038, PR China;2. State Key Laboratory of Trauma, Burn and Combined Injury, Chongqing 400038, PR China;1. Department of Biomedical and Experimental Courses, Field of Science: Pharmacology, Faculty of Medicine, University of Medicine, Tirana, Albania;2. Department of Surgery, Service of Burns and Plastic Surgery, Service of Anesthesiology, University Hospital Center “Mother Teresa”, Tirana, Albania;3. Department of Anesthesia and Intensive Care, KULeuven, Belgium |
| |
| Abstract: | BackgroundDexmedetomidine is an alpha 2-adrenergic receptor agonist. Apart from its sedative effects, dexmedetomidine can potentially reduce mortality through its anti-inflammatory effect. However, the impact of dexmedetomidine on in-hospital outcomes of patients with severe burns remains unclear. Therefore, we aimed to elucidate the association between dexmedetomidine use and mortality in mechanically ventilated patients with severe burns, using a Japanese nationwide database of in-hospital patients.MethodsWe included adults with severe burns (burn index ≥ 10) who were registered in the Japanese Diagnosis Procedure Combination national inpatient database from 2010 to 2018, started mechanical ventilation within 3 days of admission, and received any sedative drug (dexmedetomidine, midazolam, or propofol). One-to-one propensity score matching was performed between patients who received dexmedetomidine on the day of mechanical ventilation initiation (dexmedetomidine group) and those who did not receive dexmedetomidine (control group). The primary outcome was all-cause 30-day in-hospital mortality. Secondary outcomes were length of hospital stay and duration of mechanical ventilation in patients and survivors.ResultsEligible patients (n = 1888) were classified into the dexmedetomidine group (n = 371) or the control group (n = 1517). After one-to-one propensity score matching, we compared 329 patients from both groups. No significant difference was observed in the 30-day mortality between patients in the dexmedetomidine and control groups (22.8% vs. 22.5%, respectively; odds ratio, 1.02; 95% confidence interval, 0.71–1.46). Moreover, there were no significant differences between patients in the dexmedetomidine and control groups in terms of the length of hospital stay or the duration of mechanical ventilation.ConclusionsWe found no significant association between dexmedetomidine use and in-hospital outcomes (mortality, length of hospital stay, and length of mechanical ventilation) in mechanically ventilated patients with severe burns. Dexmedetomidine use may not improve the aforementioned outcomes; therefore, its selection should be based on the patient’s general condition and the target level of sedation. |
| |
| Keywords: | Burn Dexmedetomidine Sedative Mechanical ventilation Mortality |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
